Nantucket Youth Behavioral Health Assessment

Sponsor: Town of Nantucket Health and Human Services Department
Sponsor Liaison: Jerico Mele
Student Team: Simeon Hoffler Jr. Mary Laurens, Elisia McLean, Myles St. Jean
Abstract: The goal of this project was to develop a survey and interview subject matter experts to identify the mental health issues that are present within the middle and high school youth community on Nantucket. The online survey was designed to be modular and customizable to the user and contained a mixture of Likert scale, multiple-choice, and open-response questions. Based on an analysis of the survey results, follow up recommendations included conducting focus groups with schoolteachers and counselors and interviews with youth-oriented professionals, adding specific questions to the survey to obtain data on future career interest and home life, and investigating minority groups that do not have as much representation in their respective schools or communities as their peers.




An Assessment of Youth Mental Health in Nantucket, MAExecutive Summary1.0 IntroductionAccording to the Center for Disease Control, 37% of public and private high schoolersfound their mental health consistently declining during the pandemic (CDC, 2021). One of theprimary factors contributing to the decline was the switch to remote learning, which isolatedmany students from their friends and school communities (Rutkowska et al., 2022). While mostof the nation has returned to inperson learning, the impacts on youth mental health due toCOVID19 continue to persist (Puteikis et al., 2022).In light of the pandemic, growing concerns about youth mental health on Nantuckethave surfaced. The Town of Nantucket Health and Human Services Department (HHS) requiresbaseline data to quantify these concerns and to secure funding for programs to support theyouth. (J. Mele, Personal Conversation).The lack of data on Nantucket youth mental health poses a challenge in tracking theprogram efficacy of efforts made by the HHS. In fact, a behavioral health needs assessment hasnot been conducted on Nantucket since the COVID19 pandemic. For HHS to deploy servicesefficiently, baseline measurements of youth mental health must be established.The goal of this project was to design a datadriven survey tool that the NantucketHealth and Human Services Department can use to track the mental health of the youthcommunity on the island.2.0 BackgroundThe World Health Organization defines mental health as a “state of mental wellbeingthat enables people to cope with the stresses of life, realize their abilities, learn well and workwell, and contribute to their community.” (World Health Organization: WHO, 2022). In otherwords, having “good” mental health enables people to fully engage and function in theircommunities. A person struggling with poor mental health can experience feelings of loneliness,helplessness, and depression, among many others. In extreme cases, poor mental health canlead to substance abuse, selfharm, and suicide (CDC, 2023).Mental health is difficult to understand and diagnose; not everyone struggling with theirmental health experiences the same symptoms, making finding help and support complex foran adult. Children and adolescents, whose minds and social skills are still developing, needextra support to ensure they grow into confident, happy, and productive young adults.According to the Youth Risk Behavior Health Survey from the CDC in 2021, 1 in 5 students haveseriously considered attempting suicide, indicating that mental health for youth in America iscritical (Center for Disease Control, 2021).

ivCOVID19’s Impact on Youth (Grades 812)Throughout the COVID19 pandemic, the mental health of the youth community in theU.S. worsened. School closures due to the pandemic isolated many youths from the classroomand their friends, leading to increased mental and social issues (CDC,2021). A Covid ExperienceSurvey (CES) conducted in the U.S. from October 16 to November 6, 2020, examined theimpact of virtual, hybrid, and inperson learning on adolescent (1319 years old) mental healthand belonging (Hertz et al., 2022, p.59). 567 adolescents overall participated in the CES,representing 460 from public schools, 36 from private schools, and 69 from another type ofschool.Almost onehalf (44.7%) of students doing virtual learning reported high stress levels,and 34.8% reported low levels of school connectedness (Hertz et al., 2022, p.59). The datahighlights the unfavorable impact that COVID19 had on the youth community, specificallymiddle and highschoolaged students. Social isolation from the schools brought manychallenges to students, particularly students of color (Black and Hispanic). These marginalizedgroups experience many challenges, including racism and social and economic inequalities.These challenges can contribute to a feeling of decreased social fit (ICMA, 2021).Though the article does not reflect a disproportionate impact of COVID on LGBTQ+youth, other studies indicate they experienced more loneliness than cisgender heterosexualyouth (CDC, 2017). Members of the LGBTQ+ community are statistically more at risk of feelinglonely or socially isolated. Organizations such as the Trevor Project, founded in 1968, providesupport and services to youth in the LGBTQ+ community (Trevor Project, n.d.). The TrevorProject conducted four polls: two included a poll with 600 LGBTQ+ youth ages 1324, betweenJuly 21 and July 29, 2020, and another poll of 600 cisgender/straight youth ages 1324 from July21 to July 24, 2020. The Trevor Project examined the poll results and found that 68% of LGBTQ+youth reported feeling stressed compared to 56% of cis/straight gender youth amidst thefallout of the pandemic. 54% of LGBTQ+ youth also reported feeling lonely compared to 38% ofcis/straight youth (Trevor Project, 2020). These statistics from the polls examined by the TrevorProject show that the members of the LGBTQ+ community are more at risk for developingmental health issues and experiencing feelings of loneliness and hopelessness due to beingsocially isolated.Previous Survey EffortsNationalScale Survey EffortsThere are many notable initiatives to survey youth mental health nationally. Suchinitiatives are conducted by Mental Health America (MHA), the CDC, and Pride Surveys. MHAcreates a report each year on mental health in the US; within that is data specifically related toyouth, such as depressive episodes and substance use disorders, as well as treatment andinsurance information (MHA, 2022). The CDC has the Youth Risk Behavior Surveillance System(YRBSS) (CDC, 2023) and the Adolescent Behaviors and Experiences Survey (ABES) (CDC, 2022).

vBoth tools track the habits and health of high school students, with ABES focusing on theCOVID19 impact specifically. The Pride Student Survey gathers data on bullying, substanceabuse, and many more factors in grades 612 (Pride Surveys, 2023). The data theseorganizations report strengthens people’s understanding of the mental health of Americanyouth. The results of these initiatives can be shared across the country and used to impactyouth populations nationally.StateWide Survey EffortsEfforts to assess youth mental health also exist statewide. The Massachusetts YouthHealth Survey (MYHS) investigates the health of children and young adults in grades 612(Commonwealth of Massachusetts, 2021). Topics covered include chronic disabilities, drug use,obesity, and violence. The MYHS also identifies factors associated with lower youth health risk,such as having a solid support network. The Massachusetts Department of Public Health(MDPH) is responsible for this initiative, which provides datadriven insight into the mentalhealth of youth in Massachusetts specifically. This initiative allows for the isolation of datapertaining only to this state, increasing relevance, and narrowing the context of the results.Statelevel data can drive statelevel efforts to improve youth mental health.3.0 MethodsThe goal of this project was to design a datadriven survey tool that the NantucketHealth and Human Services Department can use to track the mental health of the youthcommunity on the island. The team achieved this goal through the following objectives:1. Identify factors (e.g. social or cultural) that contribute to the students’ sense ofbelonging.2. Identify the barriers that impede the students’ willingness to use current mental healthresources available in their schools and communities.3. Document the impact that the COVID19 pandemic had on the students’ mental healthand academic performance.4. Assess how the students’ involvement, or lack of involvement, in their schools andhomes (e.g. family and friends) impacted their mental health.

viMethods Used for All ObjectivesIndepth InterviewsMultiple indepth interviews were conducted individually with subject matterprofessionals. The interviews were meant to provide insight into the types of problems that theprofessionals find are prevalent in the youth community.Online Survey for WPI StudentsBefore releasing the HHS survey to Nantucket youth, the team advertised a similarversion to WPI students. This survey’s goal was to receive feedback on the survey design andcollect additional data relevant to this research. The design of this survey was consistent withthat of the Nantucket HHS survey. The main difference between the 2 surveys was the change inquestions relating to a student’s age. This version of the survey also included a question at theend requesting feedback and suggestions for survey improvement.Online Survey for Nantucket HHSThe team developed an online survey (Appendix A) with Qualtrics. The goal of thesurvey was to assess the mental health of middle and high school students, providing the teamwith baseline information on the youth population. The survey was designed to be modular sostudents could opt out of any sections they felt uncomfortable answering. Once the teamfinished creating the survey, it was sent to the Health and Human Services Department, whichadministered links to the survey to the principals of the schools. The principals then distributedthe links to the teachers and scheduled a time during the school day for the students to takethe survey.4.0 Results and FindingsOnce the HHS’ consent form distribution plan was approved by the Town of Nantucket,the link to the student survey and parental consent form was distributed to schooladministrators and through townaffiliated social media outlets. The survey was administered tostudents at Cyrus Peirce Middle School only in the absence of an optout form signed on theirbehalf. Time was allocated for these students to complete the survey during the school day onFriday, December 1st. Neither the Nantucket High School nor the Nantucket New Schoolallocated inclass time for students to complete the survey.Scoring SystemTo aid in data analysis, The team developed a scoring system for questions relating tomental health, belonging, and COVID19. This method yielded three different scores that wereused to quantify a student’s overall mental health, sense of belonging, and the experiences withlearning during the pandemic. Below is an outline explaining each of the three scores,

viihighlighting the survey questions that were used for the calculation of each score and therespective scale that each score is on.Table 4.1 displays the averages and standard deviations for the three scores among theentire population of students who took the survey.Table 4.1 Breakdown of ScoresScore Sample Size Mean Standard DeviationMental Health Score 202 3.86 0.91Belonging Score 202 3.56 1.12COVID Score 198 0.89 0.92Note: A higher score represents a healthier mental health state using the scoring system described earlier.Nantucket Youth Results and FindingsThe team received a total of 204 responses from the survey that was distributed to theNantucket Public Schools, and the Nantucket New School.Gender seemed to play a larger role in mental health scores. Male and femaleidentifying students differed by around a half point for their average Mental Health andBelonging scores, with men seeming to have better mental health and a better sense ofbelonging than women. The data also seems to point to women struggling more during virtuallearning than men according to Figure 4.1.Figure 4.1 Comparison of Mental Health (MH), Belonging (B),and COVID Scores Across Gender Identities

viiiBarriers to Mental Health ResourcesThe majority of students (66.2%) answered “No” to Question 37: “Would you ever usemental health services offered at your school?”. A thematic analysis of these students’responses to Question 38: “Why would you use or not use these services?” is shown below inFigure 4.2:Figure 4.2 Common Themes of Student HesitanceThe primary reason students said they would not use mental health services was thatthey did not feel a need to use them. Many students reported that they were not strugglingwith any issues that mental health services could fix. Others responded that they had resourcesat their disposal that they would prefer to utilize over schooloffered mental health services.The secondary reason students answered “No” to Question 37 was that they feltuncomfortable using mental health services offered at their school. Students reported that theydid not trust their school with sensitive information concerning their mental state. Othersfeared potential consequences that could arise from using these services.AcademicsStudents were asked to selfreport their overall grades in Question 23: “How would youdescribe your grades in school this year?”. Figure 4.3 shows the distribution of students for eachresponse and the average Mental Health, Belonging, and COVID score that correlated with astudent’s respective grades.

ixFigure 4.3 Comparison of Mental Health (MH), Belonging (B),and COVID Scores Relative to Students’ GradesThe graph shows a steady decline in both Mental Health Score and Belonging Score as astudent’s grades get lower. The graph also shows that students with lower grade averagestended to struggle more during the pandemic, as evidenced by the increased COVID Score. Dueto the limitations of the survey, it is unclear which factor affects which. It could be the case thathaving poor mental health causes a student to struggle with grades, or the opposite may betrue; students receiving lower grades may cause their mental health to decline. Moreconcentrated research must be conducted to further determine this relationship.InterviewsThe team interviewed Pauline Proch, an executive director of Our House and a boardmember of the Nantucket School Committee. Through this interview, the team learned moreabout the struggles that Nantucket youth are experiencing in the classroom. Her previousposition as a schoolteacher provided a valuable perspective that the team considered whilecrafting the survey. Overall, Mrs. Proch emphasized the lack of student engagement andmotivation to learn and ask critical questions that could benefit their future career andacademic endeavors.The team also interviewed Jason Bridges, a previous member of the select board ofNantucket, and the executive director of FairwindsNantucket’s Counseling Center. In speakingwith Mr. Bridges, the team learned more about the challenges that youth are facing outside theclassroom regarding extracurriculars and outside support resources. The team learned moreabout the challenges that youth are facing outside the classroom regarding extracurriculars andoutside support resources.

x5.0 Conclusions and RecommendationsConclusionsHHS SurveyTrends within the data may suggest that there is an overall lack of willingness among amajority of students to use mental health resources offered in schools. To better understandthis trend, the team performed a thematic analysis of student responses. The two mostcontributory factors to student hesitance were the perceived lack of need and a lack of comfortwith using services. These themes were consistent across more than half of the 133 studentswho said they would not use mental health services at their school. Other barriers that wereidentified included the following; questioning the helpfulness of the resource, being unawarethat such resources were available, and the stigma related to needing or using such resources.The data also may suggest that students who do not identify with the LGBTQ+community experience better mental health overall than students who do. However, becauseonly 8.5% of students identified as part of the LGBTQ+ community, further research is needed toconfirm this correlation.The team concluded that students who reported receiving lower grades experiencedworse mental health than those with higher grades. Additional research is needed to concludethe nature of this correlation, and to identify which factor influences which.InterviewsAs a result of the interviews conducted with Pauline Proch and Jason Bridges, the teamdrew the following conclusions that impacted survey design. Isolation and loneliness are prevalent concerns among the youth community onNantucket (Pauline Proch Interview, November 2023). The geographical isolation of Nantucket is a contributing factor to such feelings ofloneliness and isolation (Jason Bridges Interview, November 2023). Loneliness and isolation are two of the many implications that the COVID19 pandemichad on Nantucket youth (Pauline Proch Interview, November 2023).RecommendationsFocus Groups & InterviewsThe team recommends that future investigators contact subject matter experts, schoolfaculty, and parents of students in Nantucket and a peer community as soon as possible toschedule focus groups and interviews.Interviews with experts in the field of youth mental health could provide reputable,insightful, and wellstructured qualitative data relevant to this research. Focus groups withfaculty and parents could provide firsthand perspective of the behavioral trends observed in

xiNantucket schools and homes respectively. This insight could then be used to develop andrevise the questions for an online survey (Deaton et al., 2022). Relevant guidelines and scriptscan be found in Appendices C, D, and E.Implementing this qualitative methodology with members of a peer community, such asMartha’s Vineyard, would allow for the comparison of data gathered from Nantucket with thatof a population with similar characteristics. Such a comparison could be used to identifycommon trends between the two populations and further shape recommendations made to theHHS.The team’s success in conducting focus groups and interviews was limited by thecommunication and availability of contacted individuals. Reaching out to schedule times forfocus groups and interviews in the earliest possible stages of project work could reduce the timespent waiting for communication while on the island.Online Survey ToolThe team recommends the following, in no particular order:1. Implement survey questions related to the home environment of students.2. Implement survey questions related to academic subject affinity and career interests.3. Clarify questions which ask a participant to describe their interpretation of a word orphrase.4. Specify to survey participants that personally identifiable information should not beincluded in their responses.5. Determine survey approval processes, distribution methods, consent responsibilities,and any ethical or legal implications as soon as possible.6. Implement all survey methodologies in a peer community to Nantucket.7. Explore multiple networks of distribution for surveys.Further InvestigationThe team recommends that additional research be conducted to assess the following: The mental state of female studentsas well as minorities of gender, orientation, orethnicityrelative to that of their peers. The relationships between students’ behavioral health and their grades, substance use,and any other measurable factors.The survey responses of minorities fall short of significance to the Nantucket youthpopulation. The team suggests a more thorough investigation into the behavioral health ofstudents whose identity is underrepresented by a quantitative needs assessment of this scale.Monitoring these demographics could reveal actionable insights which inspire a higher degreeof confidence than those found by the team. Majority demographics should not be ignored,however, as even these students’ survey responses cannot stand on their own. More data isrequired to support the trends found in this study.

xiiThe team suggests that additional research be conducted to determine the correlationbetween a student’s grades and their mental health. Additionally, more investigative actionshould be taken to identify if receiving poor grades causes poor mental health, if the inverse istrue, or if there are additional factors at play. Further investigation into this topic could providedata that will allow school administrators, service providers, and parents to effectively addressthe needs of students who are struggling at school.The team’s survey tool covered a range of topics, many of which provided results thatwere too weak to draw conclusions from. However, these topics may still prove valuable toassess in future surveys, as new trends may emerge over time. Continuing to improveassessment techniques of all viably measurable student behaviors could strengthen surveymethodology and promote a more comprehensive understanding of youth mental health on theisland.6.0 BibliographyAbout Nantucket. About Nantucket | Nantucket, MA Official Website. (n.d.). (2022, March 31). Adolescent Behaviors and Experiences Survey (ABES). Centers for Disease Controland Prevention. of Massachusetts. (2021, September 8). COVID 1 9 Community Impact Survey(CCIS) of Massachusetts. (n.d.). Massachusetts Youth Health Survey (MYHS). Pride Survey for grades 612 | Pride Surveys. (n.d.). Pride Surveys. Project. (2020, August). HOW COVID19 IS IMPACTING LGBTQ YOUTH. Health Organization. (2022, June 17). Mental health. World Health Organization. (n.d.)., K., Mameniškytė, A., & Mameniškienė, R. (2022). Sleep Quality, Mental Health and Learningamong High School Students after Reopening Schools during the COVID19 Pandemic: Results of a CrossSectional Online Survey. International Journal of Environmental Research and Public Health, 19(5), 2553.